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ROP APPLICATION
Directions: Please Print Legibly
Busko,Jacob,Daniel
Name: __________________________________________

(Last)

(First)

4/9/16
____________________

(Middle)

Date

3337 el capitan ct
Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

Merced, CA, 95348
_______________________________________________________________________________

(City)

(State)

( 209 ) 628-1142

(Telephone Number)

(Zip Code)

jdbusko24@gmail.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Position applied for:_______________________________________________________________

Sports Camp Counselor
Skills and/or competencies which qualify you for this position:
Good with kids, i've played sports all my life and i'm good at teaching skills and coaching.

Languages spoken and/or written (other than English):___________________________________

none
Have you ever been convicted, pleaded guilty or no contest to a misdemeanor or felony?
No

Yes

If yes, explain:________________________________

Do you possess a valid California Drivers License?

No

Yes

_______________________
(Number)

RECORD OF EDUCATION

High School

Name of School

City/State

Merced High school

Merced, CA

Course of
study or
major

College/
University

Last year
completed
1 2 3 4

Did you
graduate?

Diploma
or degree

2016

diploma

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
I do adult league basketball on sundays

AVAILABILITY
SUNDAY

3pm and up

MONDAY

3 pm and up

TUESDAY

3pm and up

WEDNESDAY

2pm and p

THURSDAY

2 pm nd up

FRIDAY

3pm and up

FULL TIME

PART TIME

SATURDAY

all day

RECORD OF EMPLOYMENT: (Begin with your most recent job)

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Sports Camp Counselor

Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Teach kids sports and participate in activities with

the kids, feed them lunch, watch them at the pool,
keep things organized until parents pick them up,
clean up. Name:
Supervisors
Rob
_____________________________________________________

_________________________________________________

Title__________________________Last
Salary: _____________
Sports Camp Counselor

_________________________________________________

Duties:

_________________________________________________

Teach kids sports and participate in activities with

the kids, feed them lunch, watch them at the pool,
keep things organized until parents pick them up,
clean up.

_________________________________________________

To:

6/15
______

8/15
______

Mo / Yr

Mo/Yr

3
Total ____Yrs. ________Mo.

5
Hours Per Week:_________
Reason For Leaving:
only a summer job

From:

350 E Yosemite Ave, Merced, CA

To:

6/14
______

8/15
______

Mo/ Yr

Mo/Yr

3
Total ____Yrs. ________Mo.
Hours Per Week:_________
5
Reason For Leaving:

Only a summer job

Cliffs drysdale sports camp,

_________________________________________________
_________________________________________________

Cliffs Drysdale Sports Camp

350 E Yosemite Ave, Merced, CA

_________________________________________________
_________________________________________________

Supervisors Name:
Phil
________________________________________________
From:

To:

______

______

Mo /Yr

Mo/Yr

Title___________________________Last Salary: ____________

_________________________________________________

Duties:

_________________________________________________

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________

Supervisors Name:
________________________________________________

_________________________________________________

REFERENCES: Give the names of three persons not related to you.

Name
1.

Tommy Briggs

Complete Address (Include City, State, Zip)

205 West Olive Ave Merced, CA, 95340

Phone

209-349-2446

Occupation_______

Teacher/Coach

________________________________________________________________________________________________________________________________
2. Nick

Navarrette

3079 N. Parsons Ave. Merced, CA,95340

209-947-9944
Football Coach

________________________________________________________________________________________________________________________________
3.

Susan Odishoo

205 West Olive Ave Merced, CA, 95340

209-385-6437

High school Counselor

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

I understand that misrepresentation or omission of facts is cause for dismissal.

Date:_________________________Signature:_________________________________________________________________

N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf

Revised 7/10